Thursday, December 21, 2006

"tarnish the medical profession"

A doctor's delinquencyMismanagement of Subutex prescriptions results in $2,500 fine

A DOCTOR in Woodlands has been found guilty of failing to properly administer Subutex — the first such case since the medicine was listed as a controlled drug in August.

It is believed that several other doctors are under investigation for the same reason by the Singapore Medical Council (SMC).

Dr John Heng Kuo Leng was fined $2,500 by the SMC and given a stern warning for mismanaging 19 of his patients.

Incidentally, this is not the first time the 47-year-old general practitioner from First Medical Clinic and Surgery has been censured.

In 2004, he was suspended by the SMC for 18 months for dispensing addictive cough mixtures and sleeping pills too freely at his clinic in Woodlands Street 11.

This time round, one of the charges levelled at the doctor is that he did not record and provide sufficient patient details and results of the diagnosis.

A council disciplinary inquiry last week found him guilty of mismanaging the 19 patients between December 2002 and February 2004.

"The (council) unanimously found that the medical record of each of the patients concerned was very scanty and did not contain sufficient details of the patient's diagnosis, symptoms and conditions or any management plan such as to enable Dr Heng to assess properly the medical condition of the patient," said the SMC.

The council, however, was not in total agreement that he did not formulate a proper treatment plan for each of his 19 patients. But as a majority thought so, it was enough to censure him, a break from the past where convictions would be based on unanimous decisions.

Dr Heng, who has been practising since 1984, was also ordered to pledge in writing that he would not commit the same offence again. He now has to be supervised by a mentor.

Under Health Ministry guidelines, doctors must ensure proper care and supervision of their patients undergoing drug addiction treatment. They must also record all prescriptions of the drug to prevent a patient from doctor-hopping to get multiple dosages.

Dr Heng's case could be just the tip of the iceberg. In August, the SMC's executive secretary, Dr Lau Hong Choon, said the council was investigating "a number of doctors for wrongdoing in the prescription of addictive drugs like Subutex" so that errant doctors would not "tarnish the medical profession".

If found guilty, these doctors can be struck off the medical register and fined up to $10,000.

Subutex abuse came under the spotlight after heroin addicts — who were prescribed Subutex to wean them off their habit — sought highs by mixing the drug with sleeping tablet Dormicum and water, and injecting the mixture into the body.

After Subutex became a controlled drug on Aug 14, it was declared that anyone caught importing, distributing, possessing or consuming the drug faces jail and fines, unless he is a doctor or patient registered with the Government's Subutex Voluntary Rehabilitation Programme.

Doctors are no longer allowed to prescribe or dispense the drug as take-home medication.angry doc will not comment of Dr Heng's actions, since he is not in possession of all the facts of the case. Perhaps there will be more information in the SMC's annual report, perhaps not. The one piece of information angry doc is interested in knowing, however, is who the complainant was in this case.

As far as angry doc can make out from the Medical Registration Act, short of 'the conviction of a registered medical practitioner of any offence implying a defect in character which makes him unfit for his profession', or '[w]here a registered medical practitioner has been convicted in Singapore or elsewhere of an offence involving fraud or dishonesty or has contravened section 64, 65 or 67', the SMC is not supposed to initiate investigation on a doctor without a formal complaint by a named complainant.Or, as the SMC website puts it:

'The Complaints Committee can only proceed with the investigation after it has received an official complaint in writing and supported by a Statutory Declaration.

The complainant must state the full facts of his case and his allegations clearly in his letter of complaint against the doctor.'Now which patient would actually file a complaint with the SMC because his doctor kept poor records? How many Subutex abuser would actually care if their doctors kept good records? How many of them complained that they were being 'mismanaged' by their doctor (either in being given too much, or too little Subutex)?Or, if the complaint was not filed by a patient, then who filed it, and what is this person's locus standi? (Does locus standi even apply to complaints to the SMC?)Was it filed to protect patients (who can arguably be called 'victims' in this case) from the doctor's actions, or was it filed so as 'not to allow errant doctors to tarnish the medical profession'?Does any of that change the material facts of the case? Probably not.angry doc is no sympathiser of doctors who profit off the addiction of others, but nevertheless, he believes due process is important.angry doc is not against the idea of a third party acting in the interest of those who cannot or will not defend themselves from the harmful actions of their doctors. He just prefers to know who they are.

Wednesday, December 20, 2006

Cow Dung

Taken by itself this letter published in Today yesterday would be no different from the usual cow dung-type of argument for alternative medicine.

Let us go naturalTCM can keep toxins at bayLetter from Chia Hern Keng

LATELY, there has been a lot of talk about the harm of consuming trans fats. Suddenly, the table margarine that we have been using for the last 40 years is looking like poison.

Before there is widespread panic given the continual barrage of reports and letters on this danger, allow me to provide a different perspective based on what I have learnt from general concepts in Traditional Chinese Medicine (TCM).

TCM says that all foods we consume contain varying levels of tu or toxins, which can cause health problems like heart disease, diabetes and rheumatism.

It also advocates the use of foods as medicine to keep ourselves healthy rather than to seek treatment when we feel ill.

Various common herbs sold in our neighbourhood medical halls and supermarkets are in fact meant for regularly ridding our bodies of toxins that we accumulate from foods, air and other sources.

Another TCM concept is that of re chi, or heatiness — which is another word for a kind of toxin — that affects one's physical health, performance and emotions.

Thus, Chinese grannies who prepare "cooling" herbal concoctions know their therapeutic value. Alas, due to modernisation and the popularity of Western medicine, not everyone now appreciates this.

However, it must be noted that TCM detox herbs can also be toxic if consumed in large quantities, causing unwanted side-effects. A Chinese traditional physician or sinseh would be better placed to advise on this but I would also like to highlight what I think is an underrated system of healthcare.

It is impossible to avoid taking in toxins even if one sticks only to organic foods. For instance, we breathe in air that contains vehicle exhaust emissions. Electronic waves from mobile phones, TV, radio and other wireless communications are also constantly in contact with our bodies' energy fields. These cannot be altogether harmless.

So even as humans have to contend with more pathogens, let us find natural ways to rid our systems of the toxins that promote these pathogens — as a number of natural therapies like TCM and naturopathy seem to agree upon.

Mr Chia describes the paradigm of TCM, but ultimately he provides no evidence for the veracity of that paradigm, nor does he point us to any evidence that TCM can rid our bodies of such ‘toxins’.

Like I have said, taken in itself this letter would not have merited more attention, except for this article which also appeared in Today the same day.

Cancer cures: Be more waryAlternatives to conventional therapy should be taken with care, say oncologistsSheralyn Tay

An alternative option to conventional cancer treatments has its appeal but oncologists at the National Cancer Centre Singapore (NCCS) are urging their patients to be more cautious when considering such treatments.

According to Dr Donald Poon, associate consultant at NCCS, some 80 per cent of his patients are on some kind of complementary or alternative medicines (CAM), a 20 per cent leap from a study done in 1998 on cancer patients.

Dr Poon, however, is more worried about the estimated 10 per cent of patients who completely forgo conventional cancer treatment for CAM, as he believes this number may be growing.

A 50-year-old woman, who did not want to be identified, stopped her breast cancer medication in favour of a herbal paste recommended by a friend who also had cancer.

Said her son, Mike: "(Our friend) claimed that this lump actually became smaller and smaller so we decided to stop (conventional treatment) temporarily."

But more than a year later, his mother had backache, numbness, and difficulty walking. They returned to NCCS to find that the tumour had spread to the spine.

Scenarios like this could be avoided if patients take claims of cancer prevention and cures with a little more scepticism, feels Dr Poon.

Dr Swee Yong Peng, a western-trained doctor who is also vice-principal of the Singapore College of Traditional Chinese Medicine, said that he finds wild claims of cancer cures "appalling".

He stressed that if a patient chooses TCM over orthodox therapies, the same standards of care must apply, such as getting X-rays or scans done.

"(A patient or doctor) cannot just depend on taking a pulse to say you're getting better," said Dr Swee, who sees three or four patients every month who choose to forgo their western treatment, and has managed to convince about half of these patients to go back to conventional therapy.

Noting that early breast cancer is one disease best dealt with using conventional methods, he added: "If Western medicine gives you a good chance, then why forgo it for TCM?"

As for using CAM together with conventional treatment, Dr Poon said it should always be done in consultation with a doctor. An example is taking antioxidants while on cancer treatment, as antioxidation actually counters the effects of radiotherapy. Another is wheatgrass, which prolongs the recovery of low white blood cell count.

With the proliferation of supplements and foods purporting to prevent or treat cancer, consumers must assess those claims carefully, said Dr Poon.

Saturday, December 16, 2006

How NOT to argue for Alternative Medicine 6

It has been brought to my attention that my letter, "A pain in the neck for audiences" (Nov 28), may have contained misleading information with regards to visitors, both past and future, to the Omni-Theatre at the Singapore Science Centre.

This was not my intention and I hereby unreservedly apologise to the Singapore Science Centre for causing any and all harm and/or damage to their reputation as a leading institution in Singapore.

I wish to clarify that there was and is absolutely no basis — medical or otherwise — for claiming that there was a possibility of suffering a stroke from sitting in the Omni-Theatre.

In fact, the seats at the Omni-Theatre provide ample space for audiences to shift about. Moreover, the vast expanse of the screen encourages the audience to constantly turn and move their heads in order to enjoy the show.

Actually, there have been case reports that suggested that the sitting posture adopted by Dr Tio when he was in the Omni Theatre - "buttocks pushed back all the way to where the seat joins the back rest... neck extended backwards... like having my hair washed at the hairdresser's" - may precipitate a stroke. There is even a name for this: "beauty-parlour stroke".In fact, quite a number of things have been associated with precipitating a spontaneous dissection of the carotid or vertebral artery, including 'practicing yoga, painting a ceiling, coughing, vomiting, sneezing, the receipt of anesthesia, and the act of resuscitation'(source), or even falling asleep on an economy class seat in a plane. Which, of course, is not to say that sitting in the Omni Theatre will give someone a stroke, especially since the seats 'provide ample space for audiences to shift about'.Still, angry doc wonders why Dr Tio made his statement in his first letter if he thought there was 'absolutely no basis — medical or otherwise — for claiming that there was a possibility of suffering a stroke from sitting in the Omni-Theatre' to begin with, and having made that statement, why he did not cite the papers linked to above to support his statements.

Friday, December 15, 2006

Alternotopia News 3

Bonus Bogus StoryRocke may sue Alternotopia Government for Breaking PatentRocke, the crystal product manufacturer which holds the patent for quartz crystal, announced that it intends to dissuade the Alternotopia government from its plan to break its patent, and has not ruled out suing the government if it does not reverse the decision.The government had announced earlier this week that it will break the patent for quartz crystal in an effort to reduce the cost of treatment for back pain sufferers in Alternotopia. The Ministry of Health estimates that back pain affects up to 50% of working Alternotopians, and the condition is estimated to cost the nation A$1 billion each year. Crystal therapy remains the most effective cure for back pain, but the prohibitive cost of quartz crystals has meant that many sufferers could not afford the therapy."We regret that the Alternotopia government had made the decision and announcement unilaterally, and that the company had not been consulted, or asked what we could do to assist," a spokesperson for Rocke's Alternotopia subsidiary said.

Wednesday, December 13, 2006

Alternotopia News 2

Bonus Bogus StoryMan in Coma after stubbing toeA man is in a coma after stubbing his toe on a rock yesterday.Eyewitnesses told Alternotopia Times that the man was walking on the foot reflexology path at a park when he stubbed his right big toe on a cobblestone and fell, striking his head against a steel railing in the process. He was taken by ambulance to Alternotopia Reflexology Hospital (ARH).A spokesman from ARH told Alternotopia Times that reflexologists at the hospital believe that the coma is due to an accumulation of toxins in the man's brain."The big toe corresponds to the anatomical area of the brain. The swelling and brusing from the injury has disrupted the life force through the toe and prevents the discharge of toxins from the brain, and so we are applying intensive massage therapy to the area to clear the blockage," said the spokesman.

Monday, December 11, 2006

Alternative Alternative Medicine

angry doc is *shocked* by this letter published in the ST Forum today:Bird's nest, the viable alternativeMY EFFORTS to educate and advise my friends to stop consuming shark's fin have been futile.

There are two main reasons for this:

Despite shark's fin being nothing more than collagen and is tasteless in itself, it is regarded as an expensive dish.

Hence, it is seen as important to include shark's fin in the menu for a proper banquet so as not to be appear stingy towards your guests.

Most standard Chinese banquet menus include an item of shark's fin.

As Mr Bernard Harrison noted, 'Save the sharks, forgo that bowl of fin soup' (ST, Dec 6), it comprises 40 per cent of the cost of the meal. Most restaurants also do not offer viable alternatives.

In fact, I was unable to take the shark's fin option out of my own wedding dinner because my family believed that shark's fin was expected and there would be a 'loss of face' not to serve it.

If we are to start consuming less shark's fin, then the Restaurant Association of Singapore and the Singapore Chefs Association must take the lead by offering environmentally friendly alternatives in their menus that are comparable to shark's fin in terms of prestige and perceived value.

I attended a wedding at the Regent Hotel recently, and the menu included bird's nest instead of shark's fin which was a welcome surprise to me.

Bird's nest, I believe has greater nutritional value and no less valued than shark's fin.

Hopefully, the representative bodies of restaurants and chefs in Singapore can take the lead and create new dishes to replace shark's fin in banquets and make our small contribution to the conservation of the shark species.

I am sure, as we become more environmentally aware, we would welcome and endorse ethical choices in our menus.

Oscar Lee Shing KianUnfortunately, bird's nest comes from the nests of birds, and their harvesting contributes to decline to the swiftlet population, and the practice of 'farming' the birds in 'house nests' reduces the biodiversity of the birds.As for the therapeutic value of the bird's nest themselves? Well, it seems that while 'there is a water-soluble glyco-protein in the nest which promotes cell division within the immune system... it is destroyed during the cleaning process. Therefore, the soup is actually of low nutritive value.' (source)Ironically, while it is said to be good for the skin and to alleviate asthma, bird's nest soup has also been known to aggravate eczema and cause anaphylaxis in those who are allergic to it (so do a number of other foods, of course, but bird's nest was the 'most common food-allergen source' in that small study surveying a local population).

(All that is not to say that bird's nest soup is harmful to the general population, or that it cannot have any nutritive or therapeutic value at all; but in the absence of evidence, angry doc wonders if the occasional bowl at a wedding dinner is going to make much difference to one's health.)

Now angry doc is no Captain Planet nor fish- or bird-fancier, but he is nevertheless curious as to why someone would suggest replacing consumption of shark's fin with bird's nest as 'environmentally friendly', or why so many foods considered to be of therapeutic value in Traditional Chinese Medicine come from animals or animal products which are rare or hard to harvest.

(You can read more about the bird's nest trade here, and also about Singapore's role in the international trade in shark's fin and bird's nest here.)

Saturday, December 09, 2006

Return of the Dork

Alternotopia News 1

Bonus Bogus StoryMan Charged with Biomagnetic Bracelet AbuseA man was charged in court yesterday with biomagnetic bracelet abuse. If convicted, he may be sentenced for up to five years in jail.Central Neodymium Bureau (CNB) agents found the man wearing two biomagnetic bracelets during a routine search. The man, who was obesed, claimed that he had a knee-pain problem and due to his higher body weight, required two biomagnetic bracelets for effective pain-relief.Biomagnetic bracelets are widely used for pain-relief and providing a sense of well-being; however, when used excessively, it can induce euphoria and this has led to its abuse by some.The CNB reminds the public that under Alternotopia law, persons found wearing more than one biomagnetic bracelets are guilty of biomagnetic bracelet abuse, and may be sentenced to up to five years' imprisonment. Persons found in possession of five or more bracelets are presumed to be guilty of trafficking, which carries a mandatory death penalty.

Friday, December 08, 2006

All Those Years Ago

I'm shouting all about loveWhile they treated you like a dogWhen you were the one who had made it so clearAll those years agoI'm talking all about how to giveThey don't act with much honestyBut you point the way to the truth when you say"All you need is love"Living with good and badI always looked up to youNow we're left cold and sadBy someone, the devil's best friendSomeone who offended allWe're living in a bad dreamThey've forgotten all about mankindAnd you were the one they backed up to the wallAll those years agoYou were the one who imagined it allAll those years agoDeep in the darkest nightI send out a prayer to youNow in the world of lightWhere the spirit free of liesAnd all else that we despisedThey've forgotten all about GodHe's the only reason we existYet you were the one that they said was so weirdAll those years agoYou said it all though not many had earsAll those years agoYou had control of our smiles and our tearsAll those years ago- George Harrison